Coventry AMHPs tell their stories Part2

Gerry’s story

I have been a qualified social worker since 1982 and have worked in various teams and settings including residential care for the elderly, a hostel and day centre for homeless people, a child protection team, a community mental health team, a CAMHS team for looked after children and for an emergency duty team.  I have worked in the Crisis Team in Coventry for nearly 5 years. I became and Approved Social Worker in 1989 and subsequently an Approved Mental Health Professional (AMHP).

The Crisis Team offers a 24 hour service to people who are acutely mentally ill and to those in crisis who present with significant risks. We provide alternatives to admission to hospital, including home treatment and help to facilitate early discharge from hospital. The team consists of support workers, nurses, a psychologist, counsellors, psychiatrists and 7 social workers, 6 of whom are AMHPs. I have been committed to working in a multi-disciplinary way for many years. Although it may sound like a cliché now, I still believe that the product from a diverse group of professionals committed to working together is greater than the sum of the parts. I have seen the demand on our service grow considerably in my time in the team. The work is fast paced, varied, very challenging, highly stressful at times but rewarding nonetheless. There is a strong sense of mutual respect and camaraderie amongst colleagues across all disciplines. AMHPs in the Crisis Team work up to 10p.m. Once or twice per week we will be on call through the night.

The Mental Health Act provides a legal framework to follow in deciding whether or not people can be detained compulsorily for assessment or treatment of a mental disorder. Apart from those detained via the courts, AMHPs are required to be involved in making what are known as MHA assessments, usually with 2 doctors, at least one of whom will be a psychiatrist or be approved under the MHA to undertake such work. Such assessments can take place in the General Hospital, psychiatric hospital or in the person’s home. The police have powers to take people to a Place of Safety where they believe that person may be mentally disordered and in need of immediate care and control. This would lead to a formal MHA assessment, usually in the Place of Safety at the Caludon Centre but could also be at a police station or at A and E.

The role of the AMHP in my team includes the following but this is not a comprehensive list:

1. Being available for consultation with colleagues as to whether or not to proceed to a MHA assessment.
2. Considering from an early stage as to whether there is a less intrusive way of intervening with the person concerned. This may involve visiting the person and their family, building trust with them, sharing information, informing them of their rights but being honest with them about potential outcomes.
3. Considering requests for MHA assessments from the Nearest Relative.
4. Setting up MHA assessments, liaising with family, consulting with the Nearest Relative if considering the use of Section 3, requesting a bed, obtaining as much background information as possible, arranging interpreters and for doctors to attend, assessing risk in advance, organising for the police to attend if necessary, consider whether the person would want somebody to support them during the assessment and facilitate this.
5. Explain the assessment process and possible outcomes to the person, interview them in a “suitable manner”.
6. Explore alternatives to admission to hospital such as home treatment, day treatment, admission to a crisis bed.
7. Discuss with the doctors and establish whether or not the person meets the criteria for detention in hospital, whether there are viable alternatives to admission and to assert a social perspective where appropriate.
8. Help to organise and plan alternatives to admission if suitable
9. If compulsory admission is required, the doctors will complete medical recommendation forms. The person can only be detained if the AMHP then makes an application for detention in hospital, usually under Section 2 for assessment and treatment for up to 28 days or under Section 3 for treatment for up to 6 months. The AMHP would have to be satisfied that all the criteria are met, check the recommendations are completed appropriately before making an application.
10. To explain to the person of the outcome of the assessment, explain what this means, of their rights of appeal.
11. Inform the Nearest Relative of their rights.
12. To arrange transport for the person to hospital as safely as possible. This will usually be by ambulance. The police are often required to assist.
13. To apply to the court for warrants under Section 135 of the MHA in circumstances where it is felt necessary to gain access to a property, if necessary by force. The police are then required to accompany us to execute such warrants.
14. To write reports to the First Tier Tribunals where patients appeal against their detention.

Like many in the caring professions, I was drawn towards my career initially by a vague notion of wanting to help people, to do good and to make a difference. Social work values and ethics have provided a framework of beliefs and behaviours which give more clarity to the vague ideas I started out with. The degree to which I can incorporate these into my practice is I believe, a good measure of the level of satisfaction I derive from my work.  I have reflected on some of them and concluded that my current role, whilst stressful, frustrating and draining at times, these values are evident every day in what I do.

• Working with competing interests and rights. On the one hand being involved in a potentially coercive intervention of compulsory admission but on the other seeking to empower the person and their families and to seek alternatives to using that power.
• Upholding and promoting human dignity. As an AMHP, there are always opportunities to do this and may include protection from harm, considering emotional, physical, psychological, cultural and spiritual factors, offering an alternative perspective to a system which is heavily biased towards a bio medical approach to mental distress.
• Respecting the right to self-determination. This requires carefully listening to the service user’s perspective, taking time to enter into their world, to understand them as best we can and to affirm that understanding to them, even if we ultimately make decisions which would be contrary to that person’s wishes.
• Facilitating participation. This can be done as an AMHP by as far as possible enabling them to have some choice and influence leading up to and during the assessment. For example, where it should take place, who they would want to support them, seek to understand and assert their preferences.
• Adopting an holistic approach to mental disorder. I have been able to use principles and techniques I have learnt from of training in Family Therapy, Solution Focused Therapy, cognitive approaches to psychosis and counselling.
• Identifying strengths in the person and their network and building on these. Being able to do this can sometimes lead to positive risk taking which can ultimately prove to be in the service user’s best interests.
• Anti-discriminatory practice. Working in a multi-cultural city like Coventry with a client group who are deemed to have a mental disorder, being aware of prejudice and discrimination and acting in a way to counter this is a crucial aspect of the role of an AMHP.

Working in a Crisis Team involves many challenges including the ever increasing demand, the lack of psychiatric beds, difficulties in obtaining assistance from the police due to their considerably diminished resources, dealing with people who present high risk to themselves and others, increased levels of poverty, homelessness and cuts in benefits, high levels of drug and alcohol abuse. However, I have found my time in the Crisis Team to have been truly enriching and satisfying. It has been a privilege to work in a City with such diversity, with many brave, resilient service users from the city and from numerous different cultures. I am proud to be part of a team which supports people effectively through their darkest days through to safety and recovery; a team which sometimes saves lives.